As a group fitness instructor (GFI), you may encounter a wide range of emergency situations. Some may be minor (like a sprained ankle during class) or major (heavy bleeding or someone passing out during a routine). Knowing what to do in situations such as these can help you to be better prepared, and can also protect you and the participants you are instructing. Those who instruct a fitness class are required to be current on their first aid and CPR certifications.
First off, always know where the first aid kit is located. Also, make sure the kit is loaded with the necessary equipment needed to handle an emergency situation. Gloves are an absolute must. A CPR micro shield or pocket mask, mask and eye protection, blood pressure cuff, stethoscope, penlight or flashlight, splinting materials, chemical cold pack, compression wrap, hand sanitizer, sterile gauze dressings, adhesive tape, bandages, and bandage scissors are also items that should be included in the kit.
Next, follow the three rules when handling an emergency situation:
Always check the scene first to make sure it’s safe to approach the participant and when it is not. Having situational awareness will help in determining how best to handle the scene. Are you inside a building, or outdoors? Where is the nearest phone, or do you get cell phone reception? Where is the nearest hospital? Are there others nearby who can help? Also, having each participant screened before attending the class will give you a head’s up on whether someone may have a cardiovascular event or whether the individual is high-risk. Having new members sign informed consents will give them the head’s up on the risk they take when participating in a group fitness class.
Checking to make sure there is: adequate staffing, adequate lighting, non-slip surfaces around showers and pools, caution signs for wet floors, regular maintenance and repair of equipment, a clean drinking water supply, fire/smoke alarms installed, limiting the number of people in the building and in group fitness classes to avoid overcrowding, first aid kits are kept in convenient locations and you know where they are, phones that can be easily accessed; all of these things will help to reduce the risk of accidents and injuries, as well as better prepare you for when there is one.
After checking the participant and asking, “Are you OK?”, you should call EMS or have someone else do it for you. If the participant is conscious, you need to ask for consent before helping. If the participant is not conscious, consent is then applied. If there is no sign of trauma to the spine, perform a head tilt chin lift. This will move the tongue from resting on the back of the throat, which could block the airway. If there is evidence of a fall or other signs of trauma to the neck, face or head, open the airway by the jaw thrust method:
To check for breathing, it’s no longer recommended to look, listen and feel for signs. If no breath is recognized, or if breathing is gaspy or irregular, the rescuer should start chest compressions.
It’s estimated that even though many people have first aid and CPR certifications, those same people express fear and panic at having to use the skills they’ve learned. They are afraid to cause more harm than good. An interesting link re: Hands Only CPR:
Once the person is conscious and speaking, or unconscious but with a stable airway and is breathing, a secondary assessment can be made to see if there is anything else going on that is not immediately life-threatening. Check for additional injuries, abrasions, tenderness, or swelling. Checking someone’s skin color can provide information on a person’s general health. Skin that is warm and has a pinkish tone indicates good blood flow and oxygen, vs. grayish, pale skin that indicates poor circulation. You can also ask a conscious person about any allergies or medications he/she is taking.
When to call EMS:
– does not respond to voice or touch
– has chest pain
– has signs of a stroke (slurred speech, facial drooping, loss of balance, vision problems, severe headache)
– has problems breathing
– has a severe injury or burn
– has a seizure
– suddenly can’t move a part of the body
– has received an electric shock
– has been exposed to poison
– tries to commit suicide or is assaulted, regardless of the participant’s condition
– crimes in progress
– first witness of a fire, traffic, accident or chemical spill
– electrical hazards
Common medical emergencies and injuries:
Dyspnea: difficulty breathing. Using the Dyspnea Scale can help a participant determine where they are at, and if they need assistance.
If the person is conscious, putting them into a comfortable position until EMS arrives that does not involve lying flat down is helpful.
Choking: If a participant can’t breathe, make sounds, or has a very quiet cough:
Syncope: Fainting. This is considered serious when combined with exercising. Before a person faints, warning signs may be present, such as a warm sensation, nausea, or light headedness. If this occurs, have the participant sit down or lie down, and to avoid fainting, they should drink plenty of fluids to keep blood volume at adequate levels.
Seizures: In someone who is seizing; clear the area so the participant will not hit his or her head. Place a towel under the their head to protect against injury. Turn the person onto his or her side. Never restrain or place anything into the participant’s mouth. Have someone call EMS. After the seizure, make sure the person is still breathing. If not, start CPR.
Soft tissue injuries:
Contusions= bruising of the skin that cause swelling and hematoma.
Abrasion= a scraping of tissue from a fall against a rough surface
Incision= a clean cut to the skin from a sharp edge
Laceration= a jagged tear of the skin
Avulsion= a severe laceration, with skin torn away from the tissue below
Puncture= a penetration of the skin by an object
Treatment is to clean the wound completely and irrigate with water, applying a dry dressing afterwards. Applying direct pressure over the injury site can help control bleeding. It is important to seek medical attention for large wounds that continue to bleed, or if the person feels dizzy, confused, or agitated, or is pale, cool and clammy. These may be signs of shock. Always wear your gloves when performing these tasks.
Strains/Sprains: Primary treatment is RICE (rest, ice, compression and elevation).
Fractures: A disruption or break in a bone. A broken bone should be suspected when any of the following are present: deformity or angulation, pain and tenderness, swelling, disfigurement, severe weakness and loss of function, bruising, exposed bone ends, a joint locked into position, a snapping sound at the time of injury, not able to bear weight on the limb. If a break is suspected, keep the participant as still as possible. Remove or cut away clothing that covers the injury. Cover an open fracture with a sterile gauze or dressing. Leave the protruding bones if any where they are. Splinting may be helpful, but if the area of the break is too wounded or if you are not familiar with how to splint, leave the area immobile until help arrives.
Head injuries: A concussion is an injury to the brain due to an impact to the head. Concussions can cause both short and long term problems. First symptoms are confusion and disorientation. Other warning signs: amnesia, memory loss, headache, drowsiness, loss of consciousness, impaired speech, ringing in the ears, unequal pupil size, nausea, vomiting, balance problems or dizziness, blurry or double vision, sensitivity to light or noise. For any head trauma, the instructor should not move the participant. EMS should be called.
Spine injuries: When a neck or spine injury is suspected, the participant should not be moved until EMS arrives. Manual in-line stabilization, where you hold the head still, should be done until EMS can arrive and strap the person into a backboard.
Shock: Also known as hypoperfusion. Signs and symptoms of shock are: restlessness, anxiety, altered mental status, pale, cool and clammy skin, fast and weak pulse, irregular bleeding, nausea, and thirst. Shock is a serious condition which requires immediate medical attention. The GFI should initiate CPR and control severe bleeding, if any. If there is no trauma to the lower body, it is important to elevate the participant’s legs 8-12 inches and to cover them with a blanket, because shock decreases the body’s ability to regulate body temperature.